The first book of Kings relates that when Elijah's servant looked toward the sea, he saw nothing. Seven times, Elijah told him to look again, "and at the seventh time he said, 'Behold, a little cloud like a man's hand is rising from the sea.' ... And in a little while the heavens grew black with clouds and wind, and there was a great rain."
For the past year, health officials have been scanning small, isolated stories of bird flu transmission, hoping that the HN51 strain was not mutating to a form that could spread easily by person-to-person rather than bird-to-person transmission. If that happened, a pandemic with millions of deaths would be likely.
This week, World Health Organization officials are worried by evidence that six of seven people in an Indonesian family died this month after being infected by one family member who coughed frequently within a small room. The officials found "no evidence of significant mutations," but the incident put bird flu in the headlines once again and raised questions of how well the United States and other countries are prepared for what could become a great rain.
There's no question that the danger is enormous -- and no U.S. official after Katrina wants to be caught underestimating catastrophe. Late last year, the Department of Health and Human Services offered a worst-case scenario: Two million Americans die, with panicky people overwhelming hospitals, fighting for food and rioting at vaccination clinics.
The HHS projection also has 93 million people becoming ill at some point during the 16 prime weeks of pandemic, with 8.5 million people hospitalized and costs exceeding $450 billion. The Congressional Budget Office chimed in with its worst-case financial cost: $675 billion.
Some say these big numbers, based on the experience of the flu pandemic of 1918, are hysterical, since medical advances of the past century would make a huge difference: We now have antivirals, antibiotics and vaccines against many types of pneumococcal bacteria. (Not the flu itself, but secondary complications, particularly pneumonia, caused the huge death total then.) Those who say the threat is exaggerated note that improved communications since 1918 would give us warning and time to prepare.
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